Provider Demographics
NPI:1982863619
Name:OURSO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:OURSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT(ASCP)
Mailing Address - Street 1:218 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3544
Mailing Address - Country:US
Mailing Address - Phone:318-402-5443
Mailing Address - Fax:
Practice Address - Street 1:218 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3544
Practice Address - Country:US
Practice Address - Phone:318-402-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAG4308246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist